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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator 0 0 <br /> APPLICATION FOR - LAND USE - PERMITS 3. <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and „ �) <br /> located as shown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur- ° W <br /> nett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and regula- 3 a <br /> tions o the S ate of Wisconsin. <br /> N 9 <br /> a <br /> o <br /> OWNER ea int) / Contractor or Surveyor or Agent <br /> AddressAddress <br /> City,State,Zip Code City,State,Zip Code <br /> Telephone Telephone ` <br /> Em rg�n�cy/�ire Np and Road acne /� / �, / / 3 <br /> I[ �C C ,m f7�• o? 7 /r7�C�li t C�J7 a`17� <br /> Legal Description as indicated on tax stat,,, / 3O� <br /> 9 P ( r' v �CUU. �7 � J.t'� 70/7 _ <br /> Permit(s)Applied for: �'��f.C� ct <br /> 0 <br /> New Building Sanitary Filling/Grading Camping Unit w <br /> r <br /> Addition Privy Moving Subdivision o ° <br /> v <br /> Structure Use: _- 0 <br /> Directions for plot plan drawing: <br /> (family homelc in, garage, type of ddi ion, etc.) <br /> — � <br /> 1.Show the location and size of all existing buildings(EB)and all new buildings(NB)and indicate North (N). <br /> 2.Show the location of the well (W),septic tank(ST), and drainfield(DF). <br /> 3. Show the location of any lake or flowage - if within 1000 ft. and the location of any river or stream -if within 300 ft. �. <br /> 4.Show dimensions in feet of the following:(a)building to all lot lines,(b) building to center line of road,(c)building to ordi- <br /> nary high water mark of lake, river or stream, if applicable. <br /> 5. If,separate plans are submitted by an architect,engineer,builder, contractor,etc.,the plans must be signed and dated by c'1 <br /> the owner. o /XJ <br /> 3 <br /> PLOT PLAN Z C <br /> o n <br /> 5 <br /> 0 <br /> T <br /> J <br /> 9) n <br /> Cl <br /> G _ <br /> I <br /> n <br /> J <br /> 0 <br /> N � <br /> LZ <br /> Vn <br /> NC N N 0 a W m <br /> ° O< J 7 ° 6-' m <br /> y Z w y° j m 3 <br /> Z -0N <br /> m <br /> ��. <br /> :no ; <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o E :.,J : m <br /> edge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all informa- <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I N <br /> further accept all liability which may be a result of the Count of Burnett relying on this information I am providing in this ap- <br /> plication, <br /> Y Y Y Y� 9 P 9 P' <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to haveoE <br /> access to the above described premises at any reasonable time for the purpose of inspection. L <br /> Ti o:N <br /> Ni :V <br /> SIGN HERE <br /> (sig ure fowner ilding contractor) (daf 1'; off: bo <br /> ZONING ADMINISTRATOR <br /> NOV 1 31990 � N�Noom <br /> TOWNSHIP PERMITS MAY BE REQUIRED U 000000 M <br />